P1000A dietitian-led, protocolised approach to exclusive enteral nutrition improves adherence, tolerability, and quality of life in adults with Crohn’s disease: The IMPLEMENT-CD cohort study.

Abstract Background Exclusive enteral nutrition (EEN) is an established induction therapy for paediatric Crohn’s disease (CD). EEN remains underutilised in adults due to concerns about tolerability, adherence and the absence of validated adult protocols. This prospective cohort study evaluated adherence and quality of life (QoL) outcomes following implementation of a protocolised, dietitian-led EEN protocol in two tertiary adult IBD centres. Methods Adults (18 years) with active CD from inpatient and outpatient services were invited to receive 6 weeks of EEN for remission induction. Active disease was defined as CD activity index (CDAI) ≥150, faecal calprotectin 100µg/g, bowel wall thickness 3mm or increased Doppler signal on intestinal ultrasound. Patients received dietetic assessment, education, written information, a personalised EEN prescription (25-30kcal/kg/day, 1.2-1.5g/kg/day protein), and various flavours of polymeric EEN. Protocolised dietetic reviews occurred at weeks 1, 3 and 6 (Fig.1). Adherence measures included: therapy completion at 6 weeks, exclusive adherence to EEN measured by pre-defined patient-reported categories, and ability to consume the minimum prescribed EEN volume. Faecal gluten immunogenic peptide (GIP) was explored as an objective marker of diet adherence. Adverse effects were assessed at each dietetic visit, and 5-point Likert scales surveyed patient experience at week 6. QoL was assessed pre- and post-EEN with EQ-5D-5L for general QoL, IBD-Control-8 for disease control, SIBDQ for disease-related QoL and food-related QoL (FRQoL-29). Analyses used paired tests for continuous variables and univariate logistic regression for binary outcomes. Results Fifty adults (mean age 42.3±16.3 years; 34 female) were recruited from March 2022-April 2024. The 6-week course of EEN was completed by 80% (40/50). Five of 10 withdrawals were due to intolerance of a liquid diet, 82% (41/50) reporting to tolerate the taste of EEN. Of those who completed therapy, 60% (24/40) reported exclusive adherence to EEN and 95% (38/40) reported ≥75% adherence. The prescribed volume was consumed by 82.5% (33/40). GIP detected non-adherence in 30% of patients who reported non-exclusivity. Adverse effects were mild and common (constipation 54%, fatigue 54%). QoL improved across all indices (p 0.05). Among survey responders, 74% (26/35) were satisfied with EEN therapy. Frequent dietetic reviews were associated with therapy completion (p = 0.002) and exclusive adherence to EEN (p = 0.036). Conclusion In this structured, dietitian-led protocol, adult CD patients achieved high levels of adherence and completion rates, marked treatment satisfaction, and significant gains in QoL. Regular dietetic engagement is pivotal to sustaining adherence. Conflict of interest: Dr. Chu, Matthew: None Direen, Tennealle: No conflicts Mathias, Ryan: Speakers fees from Pfizer, Johnson and Johnson (Janssen), travel grant support from Dr Falk Pharma, Abbvie, consulting fees GPEx Broad, Lani: No conflicts Davis, Rachel: No conflicts Lynch, Kate: None Costello, Samuel: Employee: BiomeBank Shareholder: BiomeBank, Microbiotica Research funds and speakers fees: Janssen, Ferring, MSD, Microbiotica Edwards, Suzanne: No conflicts Bryant, Robert Venning: Robert V. Bryant has received grant/research support/speaker honoraria/advisory board fees from AbbVie, Ferring, Janssen, Shire, Takeda, GlaxoSmithKline, Bristol Myers Squibb, and Emerge Health and is a shareholder in Biomebank. Day, Alice: Research Support from The Hospital Research Foundation and Michelle McGrath Fellowship, consultancy fees from Biome Bank, Ferring, AbbVie.